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small intestine disorders clinical features investigations management medical education diagrams

mkdir -p /home/daytona/workspace/small-intestine-ppt && ls /home/daytona/workspace/small-intestine-ppt/

~/small-intestine-ppt/create_pptx.js

~/small-intestine-ppt/create_pptx.js

cat > /home/daytona/workspace/small-intestine-ppt/create_pptx.js << 'JSEOF' const pptxgen = require("pptxgenjs"); const { execSync } = require("child_process"); // Fetch images const imageUrls = [ "https://cdn.orris.care/cdss_images/158bc9cc39e323c81d9f0cccaa784bfbb067bab526f2241ccac5c8435bc1e400.png", "https://cdn.orris.care/cdss_images/d2918e8deba389a22ac8f4bbb21a6215b76958fc3eccdb92b55aa48059500ff8.png" ]; let images = []; try { images = JSON.parse(execSync( `node /home/daytona/skills/shared/scripts/fetch_images.js "${imageUrls[0]}" "${imageUrls[1]}"` ).toString()); } catch(e) { console.log("Image fetch error:", e.message); } const obsImg = images[0] && !images[0].error ? images[0].base64 : null; const stepImg = images[1] && !images[1].error ? images[1].base64 : null; console.log("obsImg loaded:", !!obsImg); console.log("stepImg loaded:", !!stepImg); const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.author = "Medical Education"; pres.title = "Disorders of Small Intestine"; const C = { navy: "0D2B55", teal: "1A7A8A", accent: "E8A020", light: "EEF4F7", white: "FFFFFF", text: "1C2B36", subtext: "4A6070", red: "C0392B", green: "1E8449", }; function sectionSlide(title, subtitle) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: "100%", h: 0.825, fill: { color: C.teal } }); sl.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.8, w: 0.12, h: 2, fill: { color: C.accent } }); sl.addText(title, { x: 0.9, y: 1.8, w: 8.5, h: 2, fontSize: 38, bold: true, color: C.white, fontFace: "Calibri" }); if (subtitle) sl.addText(subtitle, { x: 0.9, y: 3.9, w: 8.5, h: 0.7, fontSize: 18, color: C.accent, fontFace: "Calibri" }); return sl; } function contentSlide(title, bullets, opts = {}) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText(title, { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); const bw = opts.imgRight ? 5.7 : 9.4; const items = []; bullets.forEach((b, bi) => { if (typeof b === "object") { items.push({ text: b.head, options: { bullet: { type: "bullet" }, bold: true, color: C.navy, fontSize: b.size || 14, breakLine: true, fontFace: "Calibri" } }); if (b.sub) { b.sub.forEach((s, si) => { items.push({ text: " \u2022 " + s, options: { bullet: false, color: C.text, fontSize: (b.size || 14) - 1, breakLine: true, fontFace: "Calibri" } }); }); } } else { items.push({ text: b, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 13, breakLine: true, fontFace: "Calibri" } }); } }); if (items.length) items[items.length - 1].options.breakLine = false; sl.addText(items, { x: 0.3, y: 1.05, w: bw, h: 4.4, valign: "top" }); if (opts.imgRight && opts.imgData) { sl.addImage({ data: opts.imgData, x: 6.2, y: 1.1, w: 3.5, h: 3.8 }); if (opts.imgCaption) { sl.addText(opts.imgCaption, { x: 6.1, y: 4.9, w: 3.7, h: 0.5, fontSize: 9, color: C.subtext, fontFace: "Calibri", italic: true, align: "center" }); } } return sl; } function twoColSlide(title, leftItems, rightItems, leftTitle, rightTitle) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText(title, { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0, w: 4.4, h: 4.5, fill: { color: C.white }, line: { color: C.teal, width: 1.5 } }); sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.0, w: 4.4, h: 0.45, fill: { color: C.teal } }); sl.addText(leftTitle, { x: 0.3, y: 1.0, w: 4.4, h: 0.45, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); sl.addText(leftItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 12, breakLine: i < leftItems.length - 1, fontFace: "Calibri" } })), { x: 0.4, y: 1.5, w: 4.2, h: 3.9, valign: "top" }); sl.addShape(pres.ShapeType.rect, { x: 5.3, y: 1.0, w: 4.4, h: 4.5, fill: { color: C.white }, line: { color: C.accent, width: 1.5 } }); sl.addShape(pres.ShapeType.rect, { x: 5.3, y: 1.0, w: 4.4, h: 0.45, fill: { color: C.accent } }); sl.addText(rightTitle, { x: 5.3, y: 1.0, w: 4.4, h: 0.45, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); sl.addText(rightItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 12, breakLine: i < rightItems.length - 1, fontFace: "Calibri" } })), { x: 5.4, y: 1.5, w: 4.2, h: 3.9, valign: "top" }); return sl; } // ── SLIDE 1: TITLE ── { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 4.6, w: "100%", h: 1.025, fill: { color: C.teal } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.1, w: "100%", h: 0.08, fill: { color: C.accent } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.18, w: "100%", h: 0.02, fill: { color: C.white } }); sl.addText("Disorders of the Small Intestine", { x: 0.5, y: 0.3, w: 9, h: 1.75, fontSize: 40, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); sl.addText("Clinical Features \u2022 Investigations \u2022 Management", { x: 0.5, y: 2.3, w: 9, h: 0.7, fontSize: 20, color: C.accent, fontFace: "Calibri", align: "center" }); sl.addText("Including Short Gut Syndrome", { x: 0.5, y: 3.05, w: 9, h: 0.55, fontSize: 18, color: C.light, fontFace: "Calibri", align: "center" }); sl.addText("For MBBS Students | General Surgery & Medicine", { x: 0.5, y: 4.7, w: 9, h: 0.7, fontSize: 15, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); } // ── SLIDE 2: OVERVIEW ── contentSlide("Anatomy & Overview of Small Intestine", [ { head: "Three segments: Duodenum | Jejunum | Ileum", sub: ["Total length: 6-7 m in vivo (3 m contracted)", "Duodenum: 25 cm, retroperitoneal, C-shaped loop around head of pancreas"] }, { head: "Key functions", sub: ["Digestion and absorption of nutrients, water, electrolytes", "Immune surveillance via Peyer's patches and secretory IgA", "Endocrine secretion: GIP, CCK, secretin, motilin, GLP-1, GLP-2"] }, { head: "Ileum: unique absorptive sites", sub: ["Vitamin B12 (bound to intrinsic factor)", "Bile salts (enterohepatic circulation)", "Fat-soluble vitamins A, D, E, K"] }, { head: "Disorders covered in this presentation", sub: ["Inflammatory: Crohn's disease, Celiac disease, Tropical sprue", "Obstructive: Intestinal obstruction, Intussusception, Volvulus", "Malabsorptive: Short gut syndrome, SIBO", "Neoplastic: Adenocarcinoma, Carcinoid/NET, Lymphoma, GIST"] }, ]); // ── SLIDE 3: SECTION ── sectionSlide("1. Inflammatory Disorders", "Crohn's Disease \u2022 Celiac Disease \u2022 Tropical Sprue"); // ── SLIDE 4: CROHN'S CLINICAL ── contentSlide("Crohn's Disease - Clinical Features", [ { head: "Definition", sub: ["Transmural granulomatous inflammation; can affect any part of GI tract (mouth to anus)", "Most common in terminal ileum and ileocaecal region; skip lesions are hallmark"] }, { head: "Symptoms of small intestine involvement", sub: ["Abdominal pain: postprandial, crampy (partial obstruction) - present in 90% of cases", "Non-bloody diarrhoea; weight loss and anorexia", "Palpable RLQ mass (thickened bowel, abscess, or phlegmon)"] }, { head: "Complications", sub: ["Strictures leading to bowel obstruction", "Fistulas: enteroenteric, enterovesical, enterovaginal, enterocutaneous", "Abscess formation; Perianal disease (fissures, fistulas, skin tags) - in ~40%"] }, { head: "Extraintestinal manifestations", sub: ["Joints: ankylosing spondylitis, sacroiliitis, seronegative polyarthritis", "Skin: erythema nodosum, pyoderma gangrenosum", "Eyes: uveitis, episcleritis | Liver: primary sclerosing cholangitis (rare)"] }, ]); // ── SLIDE 5: CROHN'S INVESTIGATIONS & MANAGEMENT ── twoColSlide("Crohn's Disease - Investigations & Management", ["Bloods: FBC (anaemia), ESR/CRP (elevated), albumin (low)", "Stool: culture, C. diff toxin, faecal calprotectin (markedly elevated)", "Ileoscopy: cobblestone mucosa, skip lesions, deep ulcers, pseudopolyps", "CT/MRI enterography: bowel wall thickening, creeping fat, fistulas", "Barium follow-through: string sign of Kantor (stricture)", "Histology (biopsy): transmural inflammation, non-caseating granulomas"], ["Mild: 5-ASA (mesalazine)", "Moderate flare: corticosteroids (prednisolone / budesonide)", "Maintenance: azathioprine, 6-mercaptopurine", "Severe/refractory: Anti-TNF biologics (infliximab, adalimumab)", "Surgery: resection for obstruction, abscess, fistulas (bowel-sparing)", "Nutritional support: elemental diet, TPN in severe disease", "Surveillance colonoscopy after 10 years for cancer"], "Investigations", "Management" ); // ── SLIDE 6: CELIAC DISEASE ── contentSlide("Celiac Disease (Gluten-Sensitive Enteropathy)", [ { head: "Pathophysiology", sub: ["Autoimmune enteropathy triggered by dietary gluten (wheat, barley, rye)", "Genetic predisposition: HLA-DQ2 (90%) and HLA-DQ8", "IgA anti-gliadin, anti-endomysial (EMA), anti-tissue transglutaminase (anti-tTG) antibodies", "Results in villous atrophy -> malabsorption"] }, { head: "Clinical Features", sub: ["Classic: chronic diarrhoea, steatorrhoea, bloating, failure to thrive in children", "Atypical: iron-deficiency anaemia, osteoporosis, dermatitis herpetiformis, infertility, fatigue", "Silent: asymptomatic (found incidentally or on screening)"] }, { head: "Investigations", sub: ["Serology: anti-tTG IgA (sensitivity ~95%); check total IgA to exclude IgA deficiency", "Endoscopy + duodenal biopsy: villous atrophy, crypt hyperplasia, intraepithelial lymphocytes (Marsh III)", "HLA typing (DQ2/DQ8): negative result has high NPV to exclude celiac"] }, { head: "Management", sub: ["STRICT lifelong gluten-free diet (cornerstone of treatment)", "Nutritional supplementation: iron, folate, B12, calcium, vitamin D", "Refractory celiac disease: corticosteroids, azathioprine; exclude lymphoma"] }, ]); // ── SLIDE 7: TROPICAL SPRUE ── contentSlide("Tropical Sprue", [ { head: "Definition & Aetiology", sub: ["Acquired malabsorption syndrome in residents of or visitors to tropical/subtropical regions", "Likely caused by bacterial overgrowth + folate depletion (possibly Enterotoxigenic E. coli or Klebsiella)", "Affects proximal small intestine; partially overlaps with SIBO"] }, { head: "Clinical Features", sub: ["Watery diarrhoea (3-10 loose stools/day), steatorrhoea", "Macrocytic / megaloblastic anaemia (folate and B12 deficiency)", "Glossitis, angular cheilitis, oedema, profound weight loss and fatigue"] }, { head: "Investigations", sub: ["Bloods: megaloblastic anaemia; low serum folate (<3 ng/mL) and serum B12", "D-xylose absorption test: reduced (confirms absorptive defect)", "Small bowel biopsy: partial villous atrophy (less severe than celiac), not IgA-mediated", "Stool microscopy: fat globules (steatorrhoea); no parasites (distinguishes from giardiasis)"] }, { head: "Management", sub: ["Folic acid (5 mg/day) + Vitamin B12 replacement for 2-3 months", "Tetracycline 250 mg QID for 3-6 months (eradicates bacterial overgrowth)", "Most patients achieve full clinical and histological remission within weeks"] }, ]); // ── SLIDE 8: SECTION ── sectionSlide("2. Obstructive Disorders", "Intestinal Obstruction \u2022 Intussusception \u2022 Volvulus"); // ── SLIDE 9: INTESTINAL OBSTRUCTION (with image) ── { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText("Small Bowel Obstruction - Features & Management", { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); const items = []; const data = [ { head: "Causes (80%: hernias, adhesions, intussusception, volvulus)", sub: ["Adhesions (MC cause in adults - post-surgical)", "Hernias: inguinal, femoral, incisional", "Tumours; Crohn's strictures; Gallstone ileus"] }, { head: "Clinical Features", sub: ["Colicky abdominal pain, nausea and vomiting (bilious in SBO)", "Abdominal distension; absolute constipation (no flatus, no stool)", "High-pitched tinkling bowel sounds early; silent bowel in strangulation"] }, { head: "Investigations", sub: ["X-ray abdomen: dilated loops, multiple air-fluid levels (>2.5 cm), no colonic gas", "CT abdomen with contrast: transition point, identify aetiology, detect strangulation", "Blood: raised WCC, lactate (strangulation)"] }, { head: "Management", sub: ["Conservative: NBM, nasogastric tube decompression, IV fluids, electrolyte correction", "Surgery: if strangulation, perforation, peritonitis, or failed conservative management"] }, ]; data.forEach(b => { items.push({ text: b.head, options: { bullet: { type: "bullet" }, bold: true, color: C.navy, fontSize: 13, breakLine: true, fontFace: "Calibri" } }); b.sub.forEach(s => items.push({ text: " \u2022 " + s, options: { bullet: false, color: C.text, fontSize: 12, breakLine: true, fontFace: "Calibri" } })); }); if (items.length) items[items.length - 1].options.breakLine = false; sl.addText(items, { x: 0.3, y: 1.05, w: 5.65, h: 4.4, valign: "top" }); if (obsImg) { sl.addImage({ data: obsImg, x: 6.15, y: 1.1, w: 3.55, h: 3.6 }); sl.addText("FIG: Four major mechanical causes\nof intestinal obstruction\n(Robbins & Kumar Basic Pathology)", { x: 6.05, y: 4.72, w: 3.7, h: 0.75, fontSize: 9, color: C.subtext, fontFace: "Calibri", italic: true, align: "center" }); } } // ── SLIDE 10: INTUSSUSCEPTION ── contentSlide("Intussusception", [ { head: "Definition", sub: ["Telescoping of proximal bowel (intussusceptum) into distal segment (intussuscipiens)", "Most common cause of intestinal obstruction in children under 2 years"] }, { head: "Types & Causes", sub: ["Idiopathic (infants): reactive Peyer's patch hyperplasia after viral illness; rotavirus vaccine association", "Secondary (older children/adults): Meckel's diverticulum, polyp, lymphoma serve as lead point"] }, { head: "Clinical Features - Classic Triad", sub: ["Severe colicky abdominal pain (child draws knees to chest, screams intermittently)", "Redcurrant jelly stools (blood and mucus - late feature; bowel ischaemia)", "Palpable sausage-shaped mass in right upper/central abdomen", "Dance sign: emptiness in RIF as mass displaces into right upper quadrant"] }, { head: "Investigations & Management", sub: ["Ultrasound: target sign / doughnut sign (concentric rings - diagnostic)", "X-ray: may show meniscus sign, soft tissue mass in RUQ", "Air/contrast enema: diagnostic AND therapeutic - 80-90% success in children", "Surgery: peritonitis, failed reduction, or adult lead point identified"] }, ]); // ── SLIDE 11: SECTION ── sectionSlide("3. Malabsorption & Nutritional Disorders", "Short Gut Syndrome \u2022 SIBO \u2022 Nutritional Deficiencies"); // ── SLIDE 12: SGS PATHOPHYSIOLOGY ── contentSlide("Short Gut Syndrome - Definition & Pathophysiology", [ { head: "Definition", sub: ["Clinical state where residual intestine cannot maintain adequate absorption of nutrients, fluids, and electrolytes", "Usually follows massive small bowel resection (loss of >50-70% of small bowel)"] }, { head: "Common causes (adults vs. paediatric)", sub: ["Adults: Crohn's disease (MC), mesenteric ischaemia/infarction, trauma, radiation enteritis", "Neonates: NEC (35%), intestinal atresia (25%), gastroschisis (18%), midgut volvulus (14%)"] }, { head: "Key determinants of outcome", sub: ["Residual bowel length: 35-40 cm gives 50% chance of weaning off TPN; each additional cm adds 4%", "Presence of ileocaecal valve (acts as surrogate for terminal ileum integrity)", "Colon in continuity: essential for water and electrolyte salvage after massive resection"] }, { head: "Intestinal adaptation (post-resection process)", sub: ["Villous hyperplasia, crypt deepening, bowel dilation over weeks to months", "Stimulated by enteral feeding, growth factors (GLP-2 analogue: teduglutide)", "Jejunum adapts less well; terminal ileum has greatest adaptive capacity"] }, ]); // ── SLIDE 13: SGS CLINICAL + INVESTIGATIONS ── contentSlide("Short Gut Syndrome - Clinical Features & Investigations", [ { head: "Clinical Features", sub: ["Profuse watery diarrhoea / steatorrhoea; severe dehydration and electrolyte loss", "Weight loss, cachexia, failure to thrive (paediatric)", "Fat-soluble vitamin deficiencies (A, D, E, K) -> coagulopathy, metabolic bone disease, night blindness", "Vitamin B12 deficiency (ileal loss) -> macrocytic anaemia", "D-lactic acidosis (colonic bacteria ferment unabsorbed carbs) -> encephalopathy, ataxia, slurred speech"] }, { head: "Complications of long-term TPN dependence", sub: ["Catheter-related bloodstream infections (CRBSI) - most common complication", "TPN-associated liver disease / cholestasis -> fibrosis -> cirrhosis", "Gallstones: biliary stasis (100% incidence in severe SGS on long-term TPN)", "Metabolic bone disease (osteoporosis) and renal stones"] }, { head: "Investigations", sub: ["Bloods: FBC, LFTs, renal panel, electrolytes, serum vitamins (A, D, E, K, B12, folate)", "Serum zinc, selenium, magnesium, phosphate (trace elements)", "DEXA scan for bone mineral density; Abdominal USS (gallstones, liver steatosis)", "72-hr faecal fat (confirms steatorrhoea); CT/MRI enterography (residual bowel anatomy)"] }, ]); // ── SLIDE 14: SGS MANAGEMENT (with image) ── { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText("Short Gut Syndrome - Principles of Management", { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); const phases = [ { label: "Phase 1 (0-3 wks)", text: "TPN (total parenteral nutrition)\nIV fluids & electrolyte replacement\nAntidiarrhoeals: loperamide, codeine\nPPI: reduce gastric hypersecretion", col: C.red }, { label: "Phase 2 (3 wks-1 yr)", text: "Gradual introduction of oral/enteral feeds (trophic feeds)\nTPN weaned as tolerance improves\nTeduglutide (GLP-2 analogue) to stimulate adaptation", col: C.teal }, { label: "Phase 3 (>1 yr)", text: "Enteral autonomy (if adapted)\nContinue teduglutide if needed\nProkinetics; antisecretory agents\nOral rehydration solution (ORS)", col: C.green }, ]; phases.forEach((p, i) => { const x = 0.28 + i * 3.18; sl.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.0, h: 0.48, fill: { color: p.col } }); sl.addText(p.label, { x, y: 1.0, w: 3.0, h: 0.48, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); sl.addShape(pres.ShapeType.rect, { x, y: 1.48, w: 3.0, h: 1.6, fill: { color: C.white }, line: { color: p.col, width: 1.5 } }); sl.addText(p.text, { x: x + 0.08, y: 1.52, w: 2.84, h: 1.5, fontSize: 10.5, color: C.text, fontFace: "Calibri", valign: "top" }); }); sl.addText("Surgical Options (for dilated residual bowel):", { x: 0.3, y: 3.22, w: 5.55, h: 0.38, fontSize: 13, bold: true, color: C.navy, fontFace: "Calibri" }); const surgBullets = [ "Bianchi (LILT): splits mesentery into 2 planes; bowel stapled longitudinally -> doubles length, halves diameter", "STEP (Serial Transverse Enteroplasty): transverse stapling in V-shapes on alternating sides -> narrower, longer bowel", "Small bowel transplantation: last resort for irreversible intestinal failure with TPN-related complications", "Prophylactic cholecystectomy: in long-term TPN patients (virtually 100% gallstone risk)", ]; sl.addText(surgBullets.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 11, breakLine: i < surgBullets.length - 1, fontFace: "Calibri" } })), { x: 0.3, y: 3.62, w: 5.55, h: 1.85, valign: "top" }); if (stepImg) { sl.addImage({ data: stepImg, x: 6.1, y: 3.18, w: 3.6, h: 2.2 }); sl.addText("FIG: Bianchi (A) & STEP (B) bowel-\nlengthening procedures\n(Sabiston Textbook of Surgery)", { x: 6.0, y: 5.38, w: 3.8, h: 0.5, fontSize: 9, color: C.subtext, fontFace: "Calibri", italic: true, align: "center" }); } } // ── SLIDE 15: SIBO ── contentSlide("Small Intestinal Bacterial Overgrowth (SIBO)", [ { head: "Definition", sub: [">10^5 CFU/mL organisms in proximal small intestine (normally <10^4 CFU/mL)", "Normally kept low by: gastric acid, peristalsis, secretory IgA, ileocaecal valve"] }, { head: "Causes & Predisposing Factors", sub: ["Hypomotility: scleroderma, diabetic neuropathy, post-surgical (Roux-en-Y, blind loops)", "Anatomical: strictures (Crohn's), diverticula, fistulas, short gut syndrome", "Achlorhydria (PPI overuse, post-gastrectomy); immunodeficiency states"] }, { head: "Clinical Features", sub: ["Bloating, excessive flatulence, abdominal discomfort, diarrhoea, steatorrhoea", "Vitamin B12 deficiency (bacteria consume B12); fat-soluble vitamin malabsorption", "D-lactic acidosis in SGS patients with colon in continuity"] }, { head: "Investigations & Management", sub: ["Hydrogen/methane breath test (glucose or lactulose): early peak (<90 min) = SIBO", "Gold standard: jejunal aspirate and culture (>10^5 CFU/mL) - invasive", "Rifaximin 550 mg TDS x 14 days (first-line, non-absorbable antibiotic)", "Alternatives: metronidazole, ciprofloxacin; rotating antibiotics for recurrent SIBO"] }, ]); // ── SLIDE 16: SECTION ── sectionSlide("4. Neoplasms of the Small Intestine", "Benign \u2022 Malignant \u2022 Carcinoid / NET"); // ── SLIDE 17: TUMOURS TWO-COL ── twoColSlide("Small Bowel Tumours - Overview", ["Adenoma (tubular/villous - duodenum, polyp syndromes)", "GIST - Gastrointestinal Stromal Tumour (stromal, CD117+)", "Lipoma (submucosal, smooth on imaging)", "Haemangioma (cause of obscure GI bleeding)", "Peutz-Jeghers hamartomas (hamartomatous polyps)", "Brunner's gland hyperplasia (duodenal bulb)"], ["Adenocarcinoma (most common malignant - duodenum/proximal jejunum)", "Carcinoid / NET: ileum is MC site; secretes serotonin", "MALT Lymphoma (increased risk in celiac disease)", "GIST (malignant potential): KIT / PDGFRA mutations", "Metastases: melanoma (MC), lung, breast, kidney"], "Benign Tumours", "Malignant Tumours" ); // ── SLIDE 18: CARCINOID & INVESTIGATIONS ── contentSlide("Carcinoid / NET & Small Bowel Tumour Investigations", [ { head: "Carcinoid Syndrome (occurs when liver metastases bypass portal detoxification)", sub: ["Episodic cutaneous flushing (face, neck, upper chest)", "Secretory watery diarrhoea; bronchospasm (wheezing)", "Right-sided valvular disease: tricuspid regurgitation, pulmonary stenosis", "Elevated urinary 5-HIAA (>25 mg/24h); serum chromogranin A (tumour marker)"] }, { head: "Investigations for small bowel tumours", sub: ["CT/MRI enterography: mass, lymphadenopathy, liver metastases, desmoplastic reaction", "Capsule endoscopy: best sensitivity for mid-gut tumours (no biopsy capability)", "Double-balloon enteroscopy: biopsy + endoscopic therapy", "Ga-68 DOTATATE PET/CT: best for NET localisation and staging", "OGD + biopsy for duodenal tumours"] }, { head: "Management principles", sub: ["Surgical resection: curative intent for localised disease", "Carcinoid syndrome: somatostatin analogues (octreotide / lanreotide) for symptom control", "Metastatic NET: PRRT (Peptide Receptor Radionuclide Therapy) with Lu-177-DOTATATE", "GIST: imatinib (KIT inhibitor); MALT lymphoma: R-CHOP chemotherapy"] }, ]); // ── SLIDE 19: SUMMARY TABLE ── { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText("Summary: Key Disorders at a Glance", { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); const rows = [ ["Condition", "Hallmark Feature", "Key Investigation", "First-line Management"], ["Crohn's disease", "Transmural skip lesions, RLQ pain", "CT enterography, ileoscopy", "5-ASA -> steroids -> biologics"], ["Celiac disease", "Gluten enteropathy, villous atrophy", "Anti-tTG IgA + duodenal biopsy", "Lifelong gluten-free diet"], ["Tropical sprue", "Megaloblastic anaemia, tropical region", "D-xylose test, small bowel biopsy", "Folic acid + tetracycline"], ["Intestinal obstruction", "Colicky pain, distension, bilious vomiting", "AXR (air-fluid levels), CT abdomen", "NGT + IV fluids; surgery if needed"], ["Intussusception", "Redcurrant jelly stool, RUQ sausage mass", "USS (target sign)", "Air/contrast enema; surgery"], ["Short gut syndrome", "Diarrhoea, malnutrition, TPN dependence", "Serum vitamins, CT enterography", "TPN -> enteral feeds; STEP/Bianchi"], ["SIBO", "Bloating, B12 deficiency, breath test +ve", "Glucose breath test", "Rifaximin 550 mg TDS x 14 days"], ["Carcinoid/NET (ileum)", "Flushing, diarrhoea, cardiac (R-sided)", "5-HIAA, Ga-68 DOTANOC PET/CT", "Resection + octreotide"], ]; const colW = [2.0, 2.35, 2.45, 2.75]; const startX = 0.22; const startY = 1.0; const rowH = 0.46; rows.forEach((row, ri) => { row.forEach((cell, ci) => { const x = startX + colW.slice(0, ci).reduce((a, b) => a + b, 0); const y = startY + ri * rowH; const isHeader = ri === 0; sl.addShape(pres.ShapeType.rect, { x, y, w: colW[ci], h: rowH, fill: { color: isHeader ? C.teal : (ri % 2 === 0 ? C.white : "D9EFF3") }, line: { color: C.teal, width: 0.5 } }); sl.addText(cell, { x: x + 0.05, y: y + 0.03, w: colW[ci] - 0.1, h: rowH - 0.06, fontSize: isHeader ? 11 : 10, bold: isHeader, color: isHeader ? C.white : C.text, fontFace: "Calibri", valign: "middle" }); }); }); } // ── SLIDE 20: THANK YOU ── { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 3.8, w: "100%", h: 1.825, fill: { color: C.teal } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 3.75, w: "100%", h: 0.08, fill: { color: C.accent } }); sl.addText("Key Takeaways", { x: 0.5, y: 0.2, w: 9, h: 0.7, fontSize: 30, bold: true, color: C.accent, fontFace: "Calibri", align: "center" }); const takeaways = [ "Crohn's: transmural skip lesions - think complications: stricture, fistula, abscess", "Celiac: anti-tTG IgA + biopsy (Marsh III) - strict lifelong GLUTEN-FREE diet is the treatment", "Short gut syndrome: >50% resection -> TPN dependence; ileum & ileocaecal valve are critical", "Intestinal obstruction: AXR (air-fluid levels) + CT; closed-loop/strangulation = surgical emergency", "SGS surgery: STEP or Bianchi procedure to lengthen and narrow dilated residual bowel", "Carcinoid syndrome: only when liver metastases present (serotonin bypasses portal system)", "SIBO: hydrogen breath test; treat with rifaximin; address underlying cause", ]; sl.addText(takeaways.map((t, i) => ({ text: "\u2726 " + t, options: { bullet: false, color: C.white, fontSize: 13.5, breakLine: i < takeaways.length - 1, fontFace: "Calibri" } })), { x: 0.6, y: 1.0, w: 8.8, h: 2.7, valign: "top" }); sl.addText("Thank You", { x: 0.5, y: 3.82, w: 9, h: 0.55, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", align: "center" }); sl.addText("References: Sabiston Textbook of Surgery 21e | Robbins & Kumar Basic Pathology 11e | Sleisenger & Fordtran's GI & Liver Disease | Maingot's Abdominal Operations", { x: 0.5, y: 4.45, w: 9, h: 0.7, fontSize: 9.5, color: "D0E8EF", fontFace: "Calibri", align: "center" }); } pres.writeFile({ fileName: "/home/daytona/workspace/small-intestine-ppt/Small_Intestine_Disorders.pptx" }) .then(() => console.log("SUCCESS")) .catch(e => { console.error("ERROR:", e.message); process.exit(1); }); JSEOF echo "File written"

cd /home/daytona/workspace/small-intestine-ppt && node create_pptx.js

cd /home/daytona/workspace/small-intestine-ppt && curl -s -o obs_img.png "https://cdn.orris.care/cdss_images/158bc9cc39e323c81d9f0cccaa784bfbb067bab526f2241ccac5c8435bc1e400.png" && curl -s -o step_img.png "https://cdn.orris.care/cdss_images/d2918e8deba389a22ac8f4bbb21a6215b76958fc3eccdb92b55aa48059500ff8.png" && ls -lh *.png

cd /home/daytona/workspace/small-intestine-ppt && sed -i 's|// Fetch images.*||' create_pptx.js && head -5 create_pptx.js

cd /home/daytona/workspace/small-intestine-ppt && node -e " const pptxgen = require('pptxgenjs'); const fs = require('fs'); const path = require('path'); // Load images from local files const obsImgBuf = fs.readFileSync('/home/daytona/workspace/small-intestine-ppt/obs_img.png'); const stepImgBuf = fs.readFileSync('/home/daytona/workspace/small-intestine-ppt/step_img.png'); const obsImg = 'image/png;base64,' + obsImgBuf.toString('base64'); const stepImg = 'image/png;base64,' + stepImgBuf.toString('base64'); console.log('obsImg size:', obsImg.length); console.log('stepImg size:', stepImg.length); const pres = new pptxgen(); pres.layout = 'LAYOUT_16x9'; const sl = pres.addSlide(); sl.addImage({ data: obsImg, x: 1, y: 1, w: 3, h: 3 }); sl.addImage({ data: stepImg, x: 5, y: 1, w: 3, h: 3 }); sl.addText('Image test', { x: 0.5, y: 4.5, w: 9, h: 0.5, fontSize: 24, color: '000000' }); pres.writeFile({ fileName: '/home/daytona/workspace/small-intestine-ppt/test_img.pptx' }) .then(() => console.log('TEST OK')) .catch(e => console.error('ERROR:', e)); "

cat > /home/daytona/workspace/small-intestine-ppt/build_final.js << 'JSEOF' const pptxgen = require("pptxgenjs"); const fs = require("fs"); const obsImgBuf = fs.readFileSync('/home/daytona/workspace/small-intestine-ppt/obs_img.png'); const stepImgBuf = fs.readFileSync('/home/daytona/workspace/small-intestine-ppt/step_img.png'); const obsImg = 'image/png;base64,' + obsImgBuf.toString('base64'); const stepImg = 'image/png;base64,' + stepImgBuf.toString('base64'); const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.author = "Medical Education"; pres.title = "Disorders of Small Intestine"; const C = { navy: "0D2B55", teal: "1A7A8A", accent: "E8A020", light: "EEF4F7", white: "FFFFFF", text: "1C2B36", subtext: "4A6070", red: "C0392B", green: "1E8449", }; function sectionSlide(title, subtitle) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: "100%", h: 0.825, fill: { color: C.teal } }); sl.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.8, w: 0.12, h: 2, fill: { color: C.accent } }); sl.addText(title, { x: 0.9, y: 1.8, w: 8.5, h: 2, fontSize: 38, bold: true, color: C.white, fontFace: "Calibri" }); if (subtitle) sl.addText(subtitle, { x: 0.9, y: 3.9, w: 8.5, h: 0.7, fontSize: 18, color: C.accent, fontFace: "Calibri" }); } function buildItems(bullets) { const items = []; bullets.forEach(b => { if (typeof b === "object") { items.push({ text: b.head, options: { bullet: { type: "bullet" }, bold: true, color: C.navy, fontSize: b.size || 14, breakLine: true, fontFace: "Calibri" } }); if (b.sub) b.sub.forEach(s => items.push({ text: " \u2022 " + s, options: { bullet: false, color: C.text, fontSize: (b.size || 14) - 1, breakLine: true, fontFace: "Calibri" } })); } else { items.push({ text: b, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 13, breakLine: true, fontFace: "Calibri" } }); } }); if (items.length) items[items.length - 1].options.breakLine = false; return items; } function contentSlide(title, bullets, imgData, imgCaption) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText(title, { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); const bw = imgData ? 5.65 : 9.4; sl.addText(buildItems(bullets), { x: 0.3, y: 1.05, w: bw, h: 4.4, valign: "top" }); if (imgData) { sl.addImage({ data: imgData, x: 6.15, y: 1.05, w: 3.55, h: 3.7 }); if (imgCaption) sl.addText(imgCaption, { x: 6.05, y: 4.78, w: 3.7, h: 0.65, fontSize: 9, color: C.subtext, fontFace: "Calibri", italic: true, align: "center" }); } } function twoColSlide(title, leftItems, rightItems, leftTitle, rightTitle) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText(title, { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); [[leftItems, leftTitle, C.teal, 0.3], [rightItems, rightTitle, C.accent, 5.3]].forEach(([items, hdr, col, x]) => { sl.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 4.4, h: 4.5, fill: { color: C.white }, line: { color: col, width: 1.5 } }); sl.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 4.4, h: 0.45, fill: { color: col } }); sl.addText(hdr, { x, y: 1.0, w: 4.4, h: 0.45, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); sl.addText(items.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 12, breakLine: i < items.length - 1, fontFace: "Calibri" } })), { x: x + 0.1, y: 1.5, w: 4.2, h: 3.9, valign: "top" }); }); } // SLIDE 1: TITLE { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 4.6, w: "100%", h: 1.025, fill: { color: C.teal } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.1, w: "100%", h: 0.08, fill: { color: C.accent } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.18, w: "100%", h: 0.02, fill: { color: C.white } }); sl.addText("Disorders of the Small Intestine", { x: 0.5, y: 0.3, w: 9, h: 1.75, fontSize: 40, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); sl.addText("Clinical Features \u2022 Investigations \u2022 Management", { x: 0.5, y: 2.3, w: 9, h: 0.7, fontSize: 20, color: C.accent, fontFace: "Calibri", align: "center" }); sl.addText("Including Short Gut Syndrome", { x: 0.5, y: 3.05, w: 9, h: 0.55, fontSize: 18, color: C.light, fontFace: "Calibri", align: "center" }); sl.addText("For MBBS Students | General Surgery & Medicine", { x: 0.5, y: 4.72, w: 9, h: 0.7, fontSize: 15, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); } // SLIDE 2: OVERVIEW contentSlide("Anatomy & Overview of Small Intestine", [ { head: "Three segments: Duodenum | Jejunum | Ileum", sub: ["Total length: 6-7 m in vivo (3 m contracted)", "Duodenum: 25 cm, retroperitoneal, C-shaped loop around head of pancreas"] }, { head: "Key functions", sub: ["Digestion and absorption of nutrients, water, electrolytes", "Immune surveillance via Peyer's patches and secretory IgA", "Endocrine: GIP, CCK, secretin, motilin, GLP-1, GLP-2"] }, { head: "Ileum: unique absorptive sites", sub: ["Vitamin B12 (bound to intrinsic factor)", "Bile salts (enterohepatic circulation)", "Fat-soluble vitamins A, D, E, K"] }, { head: "Disorders covered", sub: ["Inflammatory: Crohn's, Celiac, Tropical sprue", "Obstructive: Intestinal obstruction, Intussusception, Volvulus", "Malabsorptive: Short gut syndrome, SIBO", "Neoplastic: Adenocarcinoma, Carcinoid/NET, Lymphoma, GIST"] }, ]); // SLIDE 3: SECTION sectionSlide("1. Inflammatory Disorders", "Crohn's Disease \u2022 Celiac Disease \u2022 Tropical Sprue"); // SLIDE 4: CROHN'S CLINICAL contentSlide("Crohn's Disease - Clinical Features", [ { head: "Definition", sub: ["Transmural granulomatous inflammation; any part of GI tract (mouth to anus)", "Most common: terminal ileum and ileocaecal region; SKIP LESIONS are the hallmark"] }, { head: "Symptoms (small intestine involvement)", sub: ["Abdominal pain: postprandial, crampy (partial obstruction) - present in 90% of cases", "Non-bloody diarrhoea; weight loss and anorexia", "Palpable RLQ mass (thickened bowel, abscess, or phlegmon)"] }, { head: "Complications", sub: ["Strictures -> bowel obstruction; Fistulas (enteroenteric, enterovesical, enterovaginal)", "Abscess formation; Perianal disease (fissures, fistulas, skin tags) in ~40%"] }, { head: "Extraintestinal manifestations", sub: ["Joints: ankylosing spondylitis, sacroiliitis, seronegative polyarthritis", "Skin: erythema nodosum, pyoderma gangrenosum", "Eyes: uveitis, episcleritis | Liver: primary sclerosing cholangitis (less common than UC)"] }, ]); // SLIDE 5: CROHN'S INX & RX twoColSlide("Crohn's Disease - Investigations & Management", ["Bloods: FBC (anaemia), ESR/CRP elevated, albumin low", "Stool: culture, C. diff, faecal calprotectin markedly elevated", "Ileoscopy: cobblestone mucosa, skip lesions, deep ulcers", "CT/MRI enterography: wall thickening, creeping fat, fistulas", "Barium follow-through: string sign of Kantor (stricture)", "Histology: transmural inflammation, non-caseating granulomas"], ["Mild: 5-ASA (mesalazine), nutritional support", "Moderate flare: corticosteroids (prednisolone/budesonide)", "Maintenance: azathioprine, 6-mercaptopurine", "Severe/refractory: Anti-TNF biologics (infliximab, adalimumab)", "Surgery: resection for obstruction/fistulas/abscess (bowel-sparing)", "Surveillance colonoscopy after 10 years for cancer risk"], "Investigations", "Management" ); // SLIDE 6: CELIAC contentSlide("Celiac Disease (Gluten-Sensitive Enteropathy)", [ { head: "Pathophysiology", sub: ["Autoimmune enteropathy triggered by dietary gluten (wheat, barley, rye)", "Genetic predisposition: HLA-DQ2 (90%) and HLA-DQ8", "Anti-tTG, anti-endomysial (EMA) IgA antibodies -> villous atrophy -> malabsorption"] }, { head: "Clinical Features", sub: ["Classic: chronic diarrhoea, steatorrhoea, bloating, weight loss, failure to thrive in children", "Atypical: iron-deficiency anaemia, osteoporosis, dermatitis herpetiformis, infertility", "Silent: asymptomatic, found on screening (e.g. relatives of known cases)"] }, { head: "Investigations", sub: ["Serology: anti-tTG IgA (sensitivity ~95%); check total IgA (exclude IgA deficiency)", "Duodenal biopsy: villous atrophy + crypt hyperplasia + intraepithelial lymphocytes = Marsh III", "HLA typing (DQ2/DQ8): high NPV to exclude celiac disease if negative"] }, { head: "Management", sub: ["STRICT lifelong gluten-free diet (cornerstone; most patients respond within weeks)", "Nutritional supplementation: iron, folate, B12, calcium, vitamin D", "Refractory celiac: budesonide, azathioprine; exclude T-cell lymphoma (EATL)"] }, ]); // SLIDE 7: TROPICAL SPRUE contentSlide("Tropical Sprue", [ { head: "Definition & Aetiology", sub: ["Acquired malabsorption in residents of / visitors to tropical/subtropical regions", "Likely caused by bacterial overgrowth + folate depletion (possibly enterotoxigenic E. coli)"] }, { head: "Clinical Features", sub: ["Watery diarrhoea (3-10 stools/day), steatorrhoea, anorexia, weight loss", "Macrocytic / megaloblastic anaemia (folate and vitamin B12 deficiency)", "Glossitis, angular cheilitis, peripheral oedema"] }, { head: "Investigations", sub: ["Bloods: megaloblastic anaemia; low serum folate (<3 ng/mL) and B12", "D-xylose absorption test: reduced (confirms villous absorptive defect)", "Small bowel biopsy: partial villous atrophy (less severe than celiac), not IgA-mediated", "Stool: fat globules; no parasites (distinguishes from giardiasis)"] }, { head: "Management", sub: ["Folic acid (5 mg/day) + Vitamin B12 replacement for 2-3 months", "Tetracycline 250 mg QID for 3-6 months (eradicates bacterial overgrowth)", "Most patients achieve full clinical and histological remission"] }, ]); // SLIDE 8: SECTION sectionSlide("2. Obstructive Disorders", "Intestinal Obstruction \u2022 Intussusception \u2022 Volvulus"); // SLIDE 9: INTESTINAL OBSTRUCTION (with obs image) contentSlide("Small Bowel Obstruction - Features & Management", [ { head: "Causes (80%: hernias, adhesions, intussusception, volvulus)", sub: ["Adhesions (MC cause in adults - post-surgical)", "Hernias: inguinal, femoral, incisional | Volvulus (midgut)", "Tumours; Crohn's strictures; Gallstone ileus"] }, { head: "Clinical Features", sub: ["Colicky abdominal pain, bilious vomiting (high SBO = early/more severe vomiting)", "Abdominal distension; absolute constipation (complete obstruction)", "High-pitched tinkling bowel sounds early; SILENT in strangulation (emergency!)"] }, { head: "Investigations", sub: ["AXR erect: dilated loops >3 cm, multiple air-fluid levels, no gas in colon", "CT abdomen with contrast: transition point, identify cause, detect strangulation", "Bloods: raised WCC, elevated lactate (warns of strangulation)"] }, { head: "Management", sub: ["Conservative (partial/early): NBM, nasogastric tube decompression, IV fluids", "Surgical: strangulation, perforation, peritonitis, complete obstruction, failed conservative"] }, ], obsImg, "FIG: Four major mechanical causes of intestinal\nobstruction: herniation, adhesions, volvulus, intussusception\n(Robbins & Kumar Basic Pathology)"); // SLIDE 10: INTUSSUSCEPTION contentSlide("Intussusception", [ { head: "Definition", sub: ["Telescoping of proximal bowel (intussusceptum) into distal segment (intussuscipiens)", "MC cause of intestinal obstruction in children under 2 years"] }, { head: "Types & Causes", sub: ["Idiopathic (infants): reactive Peyer's patch hyperplasia after viral illness; rotavirus association", "Secondary (older children/adults): Meckel's diverticulum, polyp, or lymphoma as lead point"] }, { head: "Classic Triad", sub: ["Colicky abdominal pain (child draws knees to chest, screams intermittently)", "Redcurrant jelly stools (blood and mucus - late feature; indicates bowel ischaemia)", "Palpable sausage-shaped mass in right upper/central abdomen", "Dance sign: emptiness in RIF as mass migrates to right upper quadrant"] }, { head: "Investigations & Management", sub: ["Ultrasound: TARGET SIGN / doughnut sign (concentric rings) - diagnostic", "Air/contrast enema: diagnostic AND therapeutic (80-90% success in children)", "Surgery: peritonitis, failed reduction, or adult lead point identified"] }, ]); // SLIDE 11: SECTION sectionSlide("3. Short Gut Syndrome", "Definition \u2022 Pathophysiology \u2022 Management"); // SLIDE 12: SGS PATHOPHYSIOLOGY contentSlide("Short Gut Syndrome - Definition & Pathophysiology", [ { head: "Definition", sub: ["Clinical state where residual intestine cannot maintain adequate absorption of nutrients, fluids, and electrolytes", "Usually follows massive small bowel resection (loss of >50-70% of small bowel)"] }, { head: "Common causes", sub: ["Adults: Crohn's disease (MC), mesenteric ischaemia/infarction, trauma, radiation enteritis", "Neonates/Paediatric: NEC (35%), intestinal atresia (25%), gastroschisis (18%), midgut volvulus (14%)"] }, { head: "Key determinants of outcome", sub: ["Residual bowel length: 35-40 cm gives 50% chance of weaning off TPN; each additional cm adds 4%", "Presence of ileocaecal valve (surrogate for terminal ileum integrity)", "Colon in continuity: essential for water and electrolyte salvage"] }, { head: "Intestinal adaptation (post-resection)", sub: ["Villous hyperplasia, crypt deepening, bowel dilation over weeks to months", "Stimulated by enteral feeding, growth factors (GLP-2 analogue: teduglutide)", "Terminal ileum has greatest adaptive capacity"] }, ]); // SLIDE 13: SGS CLINICAL + INX contentSlide("Short Gut Syndrome - Clinical Features & Investigations", [ { head: "Clinical Features", sub: ["Profuse watery diarrhoea/steatorrhoea; severe dehydration; electrolyte imbalances", "Weight loss, cachexia, failure to thrive (paediatric)", "Fat-soluble vitamin deficiencies (A, D, E, K) -> coagulopathy, bone disease, night blindness", "Vitamin B12 deficiency (ileal loss) -> macrocytic anaemia", "D-lactic acidosis (colonic bacteria ferment unabsorbed carbs) -> confusion, ataxia, slurred speech"] }, { head: "Complications of TPN dependence", sub: ["Catheter-related bloodstream infections (CRBSI)", "TPN-associated liver disease -> cholestasis -> cirrhosis", "Gallstones: 100% incidence in severe SGS on long-term TPN", "Metabolic bone disease (osteoporosis) and renal oxalate stones"] }, { head: "Investigations", sub: ["Bloods: FBC, LFTs, renal panel, electrolytes, vitamins (A, D, E, K, B12, folate)", "Serum zinc, selenium, magnesium, phosphate; DEXA scan for bone density", "Abdominal USS (gallstones, liver steatosis); 72-hr faecal fat collection", "CT/MRI enterography: assess residual bowel length and anatomy"] }, ]); // SLIDE 14: SGS MANAGEMENT (with step image) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText("Short Gut Syndrome - Principles of Management", { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); const phases = [ { label: "Phase 1 (0-3 wks)", text: "Total parenteral nutrition (TPN)\nIV fluids & electrolyte replacement\nAntidiarrhoeals: loperamide, codeine\nPPI: reduce gastric hypersecretion", col: C.red }, { label: "Phase 2 (3 wks-1 yr)", text: "Gradual oral/enteral feeds (trophic)\nTPN weaned as tolerance improves\nTeduglutide (GLP-2 analogue)\nto stimulate intestinal adaptation", col: C.teal }, { label: "Phase 3 (>1 yr)", text: "Enteral autonomy (if adapted)\nContinue teduglutide if needed\nOral rehydration solution (ORS)\nProkinetics / antisecretory agents", col: C.green }, ]; phases.forEach((p, i) => { const x = 0.28 + i * 3.18; sl.addShape(pres.ShapeType.rect, { x, y: 1.0, w: 3.0, h: 0.48, fill: { color: p.col } }); sl.addText(p.label, { x, y: 1.0, w: 3.0, h: 0.48, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" }); sl.addShape(pres.ShapeType.rect, { x, y: 1.48, w: 3.0, h: 1.65, fill: { color: C.white }, line: { color: p.col, width: 1.5 } }); sl.addText(p.text, { x: x + 0.08, y: 1.53, w: 2.84, h: 1.55, fontSize: 10.5, color: C.text, fontFace: "Calibri", valign: "top" }); }); sl.addText("Surgical Options for Dilated Residual Bowel:", { x: 0.3, y: 3.22, w: 5.55, h: 0.38, fontSize: 13, bold: true, color: C.navy, fontFace: "Calibri" }); const surg = [ "Bianchi (LILT): splits mesentery into 2 planes; bowel stapled longitudinally -> doubles length, halves diameter", "STEP (Serial Transverse Enteroplasty): transverse stapling in V-shapes on alternating sides -> narrower, longer bowel", "Small bowel transplantation: last resort for irreversible intestinal failure + TPN complications", "Prophylactic cholecystectomy: in long-term TPN patients (virtually 100% gallstone risk)", ]; sl.addText(surg.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, color: C.text, fontSize: 11, breakLine: i < surg.length - 1, fontFace: "Calibri" } })), { x: 0.3, y: 3.62, w: 5.55, h: 1.85, valign: "top" }); sl.addImage({ data: stepImg, x: 6.1, y: 3.18, w: 3.6, h: 2.2 }); sl.addText("FIG: Bianchi (A) & STEP (B) bowel-\nlengthening procedures\n(Sabiston Textbook of Surgery)", { x: 6.0, y: 5.38, w: 3.8, h: 0.5, fontSize: 9, color: C.subtext, fontFace: "Calibri", italic: true, align: "center" }); } // SLIDE 15: SIBO contentSlide("Small Intestinal Bacterial Overgrowth (SIBO)", [ { head: "Definition", sub: [">10^5 CFU/mL organisms in proximal small intestine (normally <10^4 CFU/mL)", "Maintained by: gastric acid, peristalsis, secretory IgA, ileocaecal valve"] }, { head: "Causes & Predisposing Factors", sub: ["Hypomotility: scleroderma, diabetic neuropathy, post-surgical (Roux-en-Y, blind loops)", "Anatomical: strictures (Crohn's), diverticula, fistulas, short gut syndrome", "Achlorhydria (PPI overuse, post-gastrectomy); immunodeficiency"] }, { head: "Clinical Features", sub: ["Bloating, excessive flatulence, abdominal discomfort, diarrhoea, steatorrhoea", "Vitamin B12 deficiency (bacteria consume B12); fat-soluble vitamin malabsorption", "D-lactic acidosis in SGS patients with colon in continuity"] }, { head: "Investigations & Management", sub: ["Hydrogen/methane breath test (glucose or lactulose): early peak (<90 min) = SIBO", "Gold standard: jejunal aspirate and culture (>10^5 CFU/mL) - invasive", "Rifaximin 550 mg TDS x 14 days (first-line, non-absorbable antibiotic)", "Address underlying cause; rotating antibiotics for recurrent SIBO"] }, ]); // SLIDE 16: SECTION sectionSlide("4. Neoplasms of the Small Intestine", "Benign \u2022 Malignant \u2022 Carcinoid / NET"); // SLIDE 17: TUMOURS twoColSlide("Small Bowel Tumours - Overview", ["Adenoma (tubular/villous - duodenum, polyp syndromes)", "GIST - stromal (CD117+, KIT mutation, spindle cell)", "Lipoma (submucosal, smooth on imaging)", "Haemangioma (cause of obscure GI bleeding)", "Peutz-Jeghers hamartomas (associated syndrome)", "Brunner's gland hyperplasia (duodenal bulb)"], ["Adenocarcinoma (most common malignant - duodenum)", "Carcinoid / NET: ileum is MC site; secretes serotonin", "MALT Lymphoma (increased risk in celiac disease)", "Malignant GIST: KIT/PDGFRA mutation", "Metastases: melanoma (MC metastasis to SB), lung, breast"], "Benign Tumours", "Malignant Tumours" ); // SLIDE 18: CARCINOID & INVESTIGATIONS contentSlide("Carcinoid / NET - Clinical Features & Management", [ { head: "Carcinoid Syndrome (occurs only when liver metastases present)", sub: ["Episodic cutaneous FLUSHING (face, neck, upper chest)", "Secretory watery DIARRHOEA; BRONCHOSPASM (wheezing)", "Right-sided valvular disease: tricuspid regurgitation, pulmonary stenosis", "Elevated urinary 5-HIAA (>25 mg/24h); serum chromogranin A (tumour marker)"] }, { head: "Investigations for small bowel tumours", sub: ["CT/MRI enterography: mass, mesenteric lymphadenopathy, liver metastases", "Capsule endoscopy: best sensitivity for mid-gut tumours (no biopsy)", "Double-balloon enteroscopy: biopsy capability + endoscopic therapy", "Ga-68 DOTANOC/DOTATATE PET/CT: localisation and staging of NETs", "OGD + biopsy for duodenal tumours; octreotide scan"] }, { head: "Management principles", sub: ["Surgical resection: curative intent for localised disease", "Somatostatin analogues (octreotide/lanreotide): carcinoid syndrome symptom control", "PRRT with Lu-177-DOTATATE: metastatic NETs unresectable", "GIST: imatinib (KIT inhibitor); MALT lymphoma: R-CHOP regimen"] }, ]); // SLIDE 19: SUMMARY TABLE { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.light } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.85, fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: "100%", h: 0.06, fill: { color: C.accent } }); sl.addText("Summary: Key Disorders at a Glance", { x: 0.2, y: 0.08, w: 9.6, h: 0.7, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" }); const rows = [ ["Condition", "Hallmark Feature", "Key Investigation", "First-line Management"], ["Crohn's disease", "Transmural skip lesions, RLQ pain", "CT enterography, ileoscopy", "5-ASA -> steroids -> biologics"], ["Celiac disease", "Gluten enteropathy, villous atrophy", "Anti-tTG IgA + duodenal biopsy", "Lifelong gluten-free diet"], ["Tropical sprue", "Megaloblastic anaemia, tropical region", "D-xylose test, small bowel biopsy", "Folic acid + tetracycline"], ["Intestinal obstruction", "Colicky pain, distension, bilious vomiting", "AXR (air-fluid levels), CT abdomen", "NGT + IV fluids; surgery if needed"], ["Intussusception", "Redcurrant jelly stool, RUQ mass", "USS (target sign / doughnut sign)", "Air/contrast enema; surgery"], ["Short gut syndrome", "Diarrhoea, malnutrition, TPN dependence", "Serum vitamins, CT enterography", "TPN -> enteral feeds; STEP/Bianchi"], ["SIBO", "Bloating, B12 deficiency, breath test +ve", "Glucose hydrogen breath test", "Rifaximin 550 mg TDS x 14 days"], ["Carcinoid/NET (ileum)", "Flushing, diarrhoea, right-sided valves", "5-HIAA, Ga-68 DOTANOC PET/CT", "Resection + octreotide/lanreotide"], ]; const colW = [2.0, 2.35, 2.45, 2.75]; const startX = 0.22, startY = 1.0, rowH = 0.46; rows.forEach((row, ri) => { row.forEach((cell, ci) => { const x = startX + colW.slice(0, ci).reduce((a, b) => a + b, 0); const y = startY + ri * rowH; const isHeader = ri === 0; sl.addShape(pres.ShapeType.rect, { x, y, w: colW[ci], h: rowH, fill: { color: isHeader ? C.teal : (ri % 2 === 0 ? C.white : "D9EFF3") }, line: { color: C.teal, width: 0.5 } }); sl.addText(cell, { x: x + 0.05, y: y + 0.03, w: colW[ci] - 0.1, h: rowH - 0.06, fontSize: isHeader ? 11 : 10, bold: isHeader, color: isHeader ? C.white : C.text, fontFace: "Calibri", valign: "middle" }); }); }); } // SLIDE 20: THANK YOU { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 3.8, w: "100%", h: 1.825, fill: { color: C.teal } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 3.75, w: "100%", h: 0.08, fill: { color: C.accent } }); sl.addText("Key Takeaways", { x: 0.5, y: 0.2, w: 9, h: 0.7, fontSize: 30, bold: true, color: C.accent, fontFace: "Calibri", align: "center" }); const takeaways = [ "Crohn's: transmural skip lesions - think COMPLICATIONS: stricture, fistula, abscess", "Celiac: anti-tTG IgA + biopsy (Marsh III) - strict lifelong GLUTEN-FREE diet", "Short gut syndrome: >50% resection -> TPN dependence; ileum and ileocaecal valve are critical", "Intestinal obstruction: AXR (air-fluid levels) + CT; strangulation = surgical EMERGENCY", "SGS surgery: STEP or Bianchi to lengthen and narrow the dilated residual bowel", "Carcinoid syndrome: ONLY when liver metastases present (serotonin bypasses portal system)", "SIBO: hydrogen breath test; treat with rifaximin; address the underlying cause", ]; sl.addText(takeaways.map((t, i) => ({ text: "\u2726 " + t, options: { bullet: false, color: C.white, fontSize: 13.5, breakLine: i < takeaways.length - 1, fontFace: "Calibri" } })), { x: 0.6, y: 1.0, w: 8.8, h: 2.7, valign: "top" }); sl.addText("Thank You", { x: 0.5, y: 3.82, w: 9, h: 0.55, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", align: "center" }); sl.addText("References: Sabiston Textbook of Surgery 21e | Robbins & Kumar Basic Pathology 11e | Sleisenger & Fordtran's GI & Liver Disease | Maingot's Abdominal Operations", { x: 0.5, y: 4.45, w: 9, h: 0.7, fontSize: 9.5, color: "D0E8EF", fontFace: "Calibri", align: "center" }); } pres.writeFile({ fileName: "/home/daytona/workspace/small-intestine-ppt/Small_Intestine_Disorders.pptx" }) .then(() => console.log("SUCCESS")) .catch(e => { console.error("ERROR:", e.message); process.exit(1); }); JSEOF echo "Script written"

cd /home/daytona/workspace/small-intestine-ppt && node build_final.js && ls -lh Small_Intestine_Disorders.pptx